No abstract

Patients with chronic HF should undergo ultrasound evaluation to quantify dyssynchrony of LV myocardial deformation, which would help identifying CRT responders.

(i) occlusion of the LAD to perform the anastomosis results in temporary impairment in left ventricular function with complete recovery on reperfusion; (ii) the use of an intracoronary shunt presumably by maintaining myocardial perfusion prevents deterioration in ventricular function; (iii) from this data it seems therefore advisable to use an intracoronary shunt in patients with unstable angina, poor left ventricular function, or in cases in which a longer time to perform the anastomosis is anticipated.

AimsIt is unclear whether myocardial velocity or deformation indices of dyssynchrony are better at predicting response to cardiac resynchronization therapy (CRT). Therefore, two indices of left ventricular (LV) dyssynchrony based on myocardial velocity and deformation were compared to predict success of CRT. Methods and resultsSixty patients with dilated cardiomyopathy, New York Heart Association class III-IV, LV ejection fraction (EF) 35%, QRS .120 ms underwent CRT. The standard deviation of the averaged time-to-peak longitudinal negative strain (T1-SD) and positive systolic velocity (Tv-SD) of 12 LV segments were calculated before and after 6 months of CRT. Responders were defined at month 6 by !20% EF increase and/or !15% end-systolic volume (ESV) decrease with respect to baseline. On univariable analysis, baseline T1-SD and Tv-SD were both significantly associated with CRT response; however, the area under the receiver operating characteristic curve was better for T1-SD. On bivariable analysis, only T1-SD retained an independent prognostic value for CRT response. Results of the analysis did not change when the logistic models were adjusted for aetiology. ConclusionBaseline dyssynchrony of longitudinal myocardial peak deformation (T1-SD) appears to be better than dyssynchrony of longitudinal myocardial peak systolic velocities (Tv-SD) for the identification of CRT responders.--

Ventricular septal defect (VSD) is a life-threatening complication of acute myocardial infarction (MI), resulting in high mortality rate even in the case of a timely approach by surgical repair. Transcatheter closure is nowadays a reliable alternative to surgery, although currently deemed challenging or unsuitable in large and complex VSD. This article reports on a successful transcatheter approach in a critically ill patient with subacute right coronary-related, complex postinfarction VSD. In this patient, two sequentially deployed Amplatzer Septal Occluder devices stabilized the clinical conditions and hemodynamic parameters.